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AFFIDAVIT FtELATING TO SECTION 13 •12 (c ) OF A GENERAL OADINANCE
OF TI3E CITY OF OSHfLOSH FiELATING TO THE LZCENSING OF ELECTAICIANS
AND PROVIDING PENALTIES
STATE OF WISCONSIN)
) SS ,
WINNEBAGO COUNTY )
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Nama Address
flret being duly aworn on oath, deposes and says that he Ss not
a 2laenaed electriclan in the City of Oshkosh and that he has
applied for an electrical permit to do electrical work .in a
reaidenoe and/or auxiliary buildings (intended solely for pur-
posea asaociated wlth a residence ) which is owned and occupled
by hlm, or is being constructed in his name , as his personal
home and that said residence or auxiliary buildings being so
wired are not to be used or erected for rental purposes or for
resale to present or proapective purchasers.
Affiant understands that the electrical work suthorized by
the permlt applied for in connectlon with this affidavit , must
be done only by this afflant and that he cannot employ others to
assist wlth the electrlcal work but members of his Smmediate
faolly.
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Dated thls � day of ��U /�' � , 19�.
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Subscrlbed and sworn to before I
thl s /�'f� da3, of � l,l� � , 19��
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� :i "�k-CC; "il
Notary pu�ill�� , Winnebago County, lJlsconsin
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